TY - JOUR
T1 - Facing the challenge of polypharmacy when prescribing for older people with cardiovascular disease. A review by the European Society of Cardiology Working Group on Cardiovascular Pharmacotherapy
AU - Tamargo, Juan
AU - Kjeldsen, Keld Per
AU - Delpón, Eva
AU - Semb, Anne Grete
AU - Cerbai, Elisabetta
AU - Dobrev, Dobromir
AU - Savarese, Gianluigi
AU - Sulzgruber, Patrick
AU - Rosano, Giuseppe
AU - Borghi, Claudio
AU - Wassman, Seven
AU - Torp-Pedersen, Christian Tobias
AU - Agewall, Stefan
AU - Drexel, Heinz
AU - Baumgartner, Iris
AU - Lewis, Basil
AU - Ceconi, Claudio
AU - Kaski, Juan Carlos
AU - Niessner, Alexander
PY - 2022/7
Y1 - 2022/7
N2 - Population ageing has resulted in an increasing number of older people living with chronic diseases (multimorbidity) requiring five or more medications daily (polypharmacy). Ageing produces important changes in the cardiovascular system and represents the most potent single cardiovascular risk factor. Cardiovascular diseases (CVD) constitute the greatest burden for older people, their caregivers, and healthcare systems.Cardiovascular pharmacotherapy in older people is complex because age-related changes in body composition, organ function, homeostatic mechanisms and comorbidities modify the pharmacokinetic and pharmacodynamic properties of many commonly used cardiovascular and non-cardiovascular drugs. Additionally, polypharmacy increases the risk of adverse drug reactions and drug-interactions, which in turn can lead to increased morbi-mortality and healthcare costs. Unfortunately, evidence of drug efficacy and safety in older people with multimorbidity and polypharmacy is limited because these individuals are frequently under-represented/excluded from clinical trials. Moreover, clinical guidelines are largely written with a single-disease focus and only occasionally address the issue of coordination of care, when and how to discontinue treatments, if required, or how to prioritize recommendations for patients with multimorbidity and polypharmacy.This review analyses the main challenges confronting healthcare professionals when prescribing in older people with CVD, multimorbidity and polypharmacy. Our goal is to provide information that can contribute to improve drug prescribing, efficacy, and safety, as well as drug adherence and clinical outcomes.
AB - Population ageing has resulted in an increasing number of older people living with chronic diseases (multimorbidity) requiring five or more medications daily (polypharmacy). Ageing produces important changes in the cardiovascular system and represents the most potent single cardiovascular risk factor. Cardiovascular diseases (CVD) constitute the greatest burden for older people, their caregivers, and healthcare systems.Cardiovascular pharmacotherapy in older people is complex because age-related changes in body composition, organ function, homeostatic mechanisms and comorbidities modify the pharmacokinetic and pharmacodynamic properties of many commonly used cardiovascular and non-cardiovascular drugs. Additionally, polypharmacy increases the risk of adverse drug reactions and drug-interactions, which in turn can lead to increased morbi-mortality and healthcare costs. Unfortunately, evidence of drug efficacy and safety in older people with multimorbidity and polypharmacy is limited because these individuals are frequently under-represented/excluded from clinical trials. Moreover, clinical guidelines are largely written with a single-disease focus and only occasionally address the issue of coordination of care, when and how to discontinue treatments, if required, or how to prioritize recommendations for patients with multimorbidity and polypharmacy.This review analyses the main challenges confronting healthcare professionals when prescribing in older people with CVD, multimorbidity and polypharmacy. Our goal is to provide information that can contribute to improve drug prescribing, efficacy, and safety, as well as drug adherence and clinical outcomes.
KW - Adverse drug reactions
KW - Drug–drug and drug–disease interactions
KW - Inappropriate prescribing
KW - Older people
KW - Pharmacokinetic and pharmacodynamic changes
KW - Polypharmacy
UR - http://www.scopus.com/inward/record.url?scp=85131770915&partnerID=8YFLogxK
U2 - 10.1093/ehjcvp/pvac005
DO - 10.1093/ehjcvp/pvac005
M3 - Review article
SN - 2055-6837
VL - 8
SP - 406
EP - 419
JO - European Heart Journal - Cardiovascular Pharmacotherapy
JF - European Heart Journal - Cardiovascular Pharmacotherapy
IS - 4
ER -